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Medicare Part D: CMS Nixes Proposed Independent Pharmacist Requirement

by Published On: Dec 14, 2011Updated On: Apr 05, 2012

The Centers for Medicare and Medicaid Services (CMS) released the final rule for Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Changes, which contains 2 provisions for which we advocated:

  1. CMS is nixing its proposed requirement that nursing homes hire fully independent long-term care (LTC) consultant pharmacists.  
  2. CMS concurred with our position that Medicare should allow Dual Eligible Special Needs Managed Care Plans meeting certain standards to offer additional supplemental home and community-based benefits to its eligible subscribers beyond the supplemental benefits Medicare Advantage plans are allowed to offer. 

Independent Long-Term Care Consultant Pharmacists  

CMS will continue to consider changes to long-term care organizations conditions of participation relating to pharmacy services. In the proposed rule, CMS reported that it was considering a requirement for long-term care consultant pharmacists to be independent of any affiliations with a nursing home's pharmacies, pharmaceutical manufacturers and distributors, or any affiliates of these entities. 

CMS argued that such a requirement would be necessary to ensure that independent long-term care consultant pharmacist decisions were objective, unbiased, and in the best interest of nursing home residents.

CMS analyzed stakeholder comments to the proposed provision, and through this review, CMS has determined that this requirement did not provide a comprehensive solution to concerns of the over-prescribing of drugs in long-term care settings and so, is not finalizing the proposal at this time. 

From comments received on this issue, CMS now believes a more targeted and less disruptive approach is warranted. As such, CMS is soliciting additional comments to help determine a more comprehensive approach to eliminate overprescribing and the use of chemical restraints in nursing homes. 

CMS is strongly encouraging the long-term care field to voluntarily adopt the following changes to increase transparency: 

  • Separate long-term care consultant contracting for dispensing and other pharmacy services.
  • Pay fair market rates for consultant pharmacist services.
  • Disclose to long-term care organizations any affiliations of consultant pharmacists that pose potential conflicts of interest (this may include the execution of consultant pharmacist integrity agreements.).

CMS is urging long-term care practices and stakeholders to implement changes to address these concerns that will result in a decrease in inappropriate prescribing. 

If improvements in inappropriate utilization do not occur, the agency will use a future notice and comment rulemaking to propose requirements to comprehensively address these concerns. 

Dual Eligible Special Needs Managed Care Plans 

The final rule allows Dual Eligible Special Needs Managed Care Plans (D-SNPs) meeting certain integration and performance standards to offer additional supplemental benefits to its eligible subscribers beyond those supplemental benefits Medicare Advantage plans are allowed to offer.   

On an annual basis, CMS can approve benefits that better integrate care for the dual eligible population, such as non-skilled nursing services, personal care services and other long-term care services and supports designed to keep dual eligible beneficiaries out of institutions.  

CMS would require D-SNPs that offer these additional supplemental benefits to do so at no additional cost to the beneficiary.  

CMS believes that qualifying D-SNPs granted this supplemental benefit flexibility could help prevent health status decline and reduce the quantity and cost of future health care needs. 


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